Researching Psilocybin’s Effects on Depression – Dr. Rosalind Watts

The Psychedelic Research Group focuses on two main areas: first, the action of psychedelic drugs in the brain and second, their clinical utility, e.g. as aides to psychotherapy, with a particular focus on depression.

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Craig Cannon [00:00] – Hey, how’s it going? This is Craig Cannon and you’re listening to Y Combinator’s podcast. Today’s episode is with Dr. Rosalind Watts. She’s a clinical psychologist at the Psychedelic Research Group at Imperial college in London. The Psychedelic Research Group focuses on two main areas. First, the action of psychedelic drugs in the brain and, second, their clinical utility. In this episode, Rosalind and I talk about their study of how psilocybin aka mushrooms can affect depression. If you want to learn more about their research, I will link it up in the description and on the blog. Alright, here we go. How did this particular research project get started?

Dr. Rosalind Watts [00:41] – This particular research started after various other studies looking into the effects of psilocybin on the brain and LSD on the brain. This was the work of Robin Carhart-Harris. His interest came out of his own psychoanalytic studies and his also work as a neuroscientist and he was very interested in how we can explore the unconscious mind because so much of our behavior is controlled by the unconscious mind and, yet, it’s very difficult to study scientifically. Psychoanalysis is very, it almost seems more of an art than a science. He wanted to find ways in of looking at the brain, the unconscious mind. He started studying psychedelics with David Nutt. David Nutt is quite well-known professor in this country for his activism in legalizing drugs. He worked for the government. He was the drug czar. He informed them or advised them about the scientific harms of different drugs and how they should be scheduled or where they should be in the schedule of illegal drugs. And he was sacked, very famously, because his scientific report stated that MDMA was less dangerous than horse riding.

Dr. Rosalind Watts [02:01] – He was sacked for that and he has gone on to be a real innovator in drugs policy and drugs research. Just recognizing that lots of the drugs that are illegal might hold potential for healing, whereas alcohol and cigarettes that are legal, really don’t, saying, “It’s time for a more free-thinking approach.” It was David and Robin together that started this research and it was very difficult for them because there’s so much red tape around this. Because since it was made illegal in the early 70s, it’s been very hard to get a license from the home office to do this research. But once they’d gone through the process, it became easier for them to then do another study and another study, so they’ve really been on a roll. They did some studies looking at the effects of psilocybin and LSD on the brain. And then they realized that the findings that they had indicated to them that it was time to start looking at psilocybin with a clinical population. The key finding was that psilocybin seems to deactivate the part of your mind, your brain, that is responsible for ruminating, for negative thinking on a loop. They realized that for people with depression, this could be really powerful. The study that I was involved in was a clinical study looking at 20 people with treatment-resistant depression and it was the first study of its kind in the U.K. and there’ve been some studies in the U.S. looking at psilocybin with people with depression and anxiety secondary to a diagnosis of a terminal illness.

Craig Cannon [03:40] – Are these the studies that were happening in the ’60s and ’70s or are there more recent work?

Dr. Rosalind Watts [03:46] – In the ’50s, ’60s and ’70s there were hundreds and thousands of studies and the findings were really very positive and it all looked great. And then it became illegal. And then the research just dropped away. But then it started again in the early 2000s, maybe 2006, around that time. Maybe slightly earlier than that. Some of the people that had been involved in psychedelic research in the ’60s started to say, “Ah, we really need these tools. They were really working. We need to get them back again.” Bill Richards, who is a psychologist, had been working in one of the clinics in the U.S. The Maryland Psychiatric At-Risk Center had this clinic there. There are some good YouTube videos showing people having LSD sessions. You can see the psychiatrist sitting there with a woman who is on her LSD trip. They basically realized that it was time to go again. They galvanized their team, got a new group together and started up again.

Craig Cannon [05:04] – This was just these drugs had existed at the university and they just had a store of them or they lobbied to make this happen? How did it go?

Dr. Rosalind Watts [05:14] – How did they actually get the substance?

Craig Cannon [05:14] – Yeah.

Dr. Rosalind Watts [05:18] – There are various companies now that are synthesizing psilocybin. They can provide it to researchers with a license to use the Schedule 1 drugs. In order to use them in a study, you usually need it to be GMP grade which means it’s very pure and able to be used. That it’s gone through lots of testing. There are very few providers of GMP psilocybin. A lot of the difficulty of doing this research isn’t just the bureaucracy, cutting through the red tape, getting the licenses, the lack of funding because the governments obviously don’t often want to fund this. It’s also actually getting the psilocybin and getting enough of it and getting it that’s stable and been tested.

Craig Cannon [06:01] – What clued you into the fact that it was working with depression and versus some other trait that it might affect?

Dr. Rosalind Watts [06:08] – It will be helpful for so many different mental health difficulties. But with depression, it’s the ruminating quality of depression. The fixation on certain ideas and concerns. Psilocybin and psychedelics seem to be very good at, when people are stuck in a very fixed pattern of thinking or of living, psychedelics can break that pattern. They can provide this state of … When you look at the images of brain communication pathways they go from this kind of segmented lines to this full-on explosion where things that, parts of the brain that don’t talk to each other will talk to each other and suddenly there’s this flexibility.

Craig Cannon [06:56] – I’m curious about what the experience is for the following days, but before we jump in, we should talk about what one of these sessions actually looks like.

Dr. Rosalind Watts [07:05] – Yes. In the last study there was a low-dose and a high-dose session. The low-dose session was 10 milligrams and the high-dose was 25 and they look pretty different, these sessions. Firstly, the setting is that people would come into the clinic and they will have had some sessions with their guides beforehand. Everybody has two guides. The clinic has clinicians, therapists and they get to know the participant quite well. We have some sessions where you just share about their lives and hear their story and you tell them a bit about yourself and it’s quite a nice human, equal relationship. Very respectful. And quite different to some doctor-patient kind of–

Craig Cannon [07:51] – Have you done both? Like both type of relationships?

Dr. Rosalind Watts [07:53] – Yes.

Craig Cannon [07:53] – Okay, alright.

Dr. Rosalind Watts [07:55] – Very different. I was working in the NHS as a therapist with lots of patients and there, you’re so busy, you have seven people coming every day. And there’s this huge need and often you don’t really have the tools to help people because, often talking therapy doesn’t really work, especially if you can only offer people six sessions. You’re aware that people have this need and that they’re so desperate and in crisis and there’s not much you can do. In a way, when that happens is you put your barriers down. You put boundaries down. It’s like, “This is what I can do. This is what I can’t do.” And you keep yourself a bit separate.

Craig Cannon [08:39] – And what happens to those people? They have to go private somewhere?

Dr. Rosalind Watts [08:42] – These are usually people that really wouldn’t have the money to go privately. They just, they come for their sessions and you give them what you can, but you can only give them six sessions so there’s this sense of it not being enough. And it’s hard for them. And it’s hard for you. And it’s hard for everybody there and then they will often get antidepressants because that’s something that the doctor can easily prescribe and it feels like it’s doing something. But then often that doesn’t work either.

Craig Cannon [09:06] – Okay. Are antidepressants prescribed at the same rate that they are in the U.S., here in the U.K.?

Dr. Rosalind Watts [09:12] – They’re prescribed incredibly frequently. Last year was our record number of antidepressant prescriptions. There were 64.7 million prescriptions in the U.K. of antidepressants last year.

Craig Cannon [09:22] – How many people live in the U.K.?

Dr. Rosalind Watts [09:24] – I don’t know, but it’s a lot more people than you would imagine. It’s a huge use of antidepressants that isn’t really talked about very much. As a short-term thing to get people who are crisis time, I think sometimes it can be really helpful. And for some people, it works. For a lot of people it’s a short-term fix. It doesn’t really change the causes of the depression.

Craig Cannon [09:52] – In these psilocybin sessions you more, you’re just like having a conversation like you would between friends before you get going. Someone gets comfortable with you.

Dr. Rosalind Watts [10:03] – You feel really comfortable, you are going through something together. You’re on a journey together. And you’ve been through all the different things that can happen and how to manage a session, and–

Craig Cannon [10:15] – Oh, so it’s like a Q&A, as well.

Dr. Rosalind Watts [10:17] – Yeah.

Craig Cannon [10:17] – I show up and you’re like, “Okay, here we go.” And then I ask you–

Dr. Rosalind Watts [10:22] – We’d have a couple of sessions beforehand to get to know each other. Then you would tell me about your life story and the difficult things that had happened and the things that you were scared would come up because they often do. All the things you don’t want to talk about might well come up, so all the taboos. You talk about sex and death and all the things that people hide in their closets. Then when that’s all been openly talked about, then you’re ready go. They come in to the clinic. They have the capsules. In the low-dose session it’s just two capsules and then they sit there with their two guides in a room that’s full of nice decorations. It was in a hospital but it doesn’t look like a hospital room. They have a playlist of really beautiful music that’s been specially designed for this experience. They sit there through the day. On a 10-milligram dose you would tend to see more psychodynamic stuff, so internal exploration. People feeling more emotional. Feeling that they maybe get some insight into different parts of their life. Often there’s a struggle. Because the amount of psilocybin is… Their ego is still intact. There is still an I there. You would still be there, knowing who you are, just more in touch with stuff the that’s going on but you don’t often think about. The stuff that’s been pushed away.

Craig Cannon [11:48] – In other words, you can put a finger on it and you can identify it, but you don’t let go of it or how would you put it?

Dr. Rosalind Watts [11:55] – The difference between a 10-milligram dose and a 25-milligram dose usually is that a 25-milligram dose is so high that you can’t resist it. With a 10-milligram dose, imagine it’d be like this… With 10 milligrams, imagine you’ve got this cellar. Do you use the word cellar in the U.S.?

Craig Cannon [12:12] – Yeah, basement or…

Dr. Rosalind Watts [12:13] – Basement, you’ve got a basement. In the basement there are all the skeletons and the monsters and the things that you have pushed away. And what psilocybin does, is it can open the door of that stuff so that you can process it. So that you can go through those things and be freer of them as you go forward in your life. It’s not just the monsters that are down there, there’s other really amazing things, but it’s intense. Taking the psilocybin is a bit like opening that door and you have to let go and surrender to whatever is coming up. You have to be there and welcome it. With 10 milligrams it opens it a little bit. The things come out and you might be having a conversation with a dead parent or you might be thinking about a relationship that ended. It’s like a very intense turbocharged therapy session. But you can fight it. You can kind of put the lid down. You can decide you don’t want to do it. With 25 milligrams, you can’t fight it. You can’t say, “I don’t want to deal with this. I’ve decided I don’t want to.” It’s open, everything comes out and you just have to surrender and just trust in the process.

Craig Cannon [13:18] – And your role as the psychologist, what are you doing throughout in a 10 and a 25-milligram session?

Dr. Rosalind Watts [13:25] – Helping people surrender. Helping people face the things that are difficult. Helping people sit through the pain of it and, by being encouraging that that’s the right thing to do, that they’re safe. People sometimes feel that they’re dying because when the ego is deactived, that’s quite common because when your ego is deactivated you have no sense of self, and sometimes that’s a beautiful experience. When I talk about the basement being open it sounds like it’s always really difficult. It’s often a really beautiful experience for people. Often there’ll be a bit of both. But when you die on a psychedelic experience, when you have an ego death, that can either feel like “Ah, I’m at one with the planet. I am the clouds and the trees. I am everything.” Or, it can feel like, “I’m physically being killed and dying.”

Dr. Rosalind Watts [14:17] – “This is exactly what you came here to do, you know. It’s counter-intuitive. If you feel that you’re going mad, great, go mad. If you feel like you’re dying, go die. If you’re exploding, let’s see what it’s like to explode.” It’s about, in a way, the whole concept of mindfulness and meditation is about allowing things in and just sitting with them, rather than distracting or pushing them away or trying to always be kind of achieving or feeling good, but never feeling your feelings. And it’s about that. It’s like turbocharged mindfulness. It’s whatever is here, let it be here. Don’t fight it. Don’t push it away. Don’t try and nullify these negative emotions. Do sadness. Do suffering fully.

Craig Cannon [15:00] – Is there a certain vocabulary that you train someone in before they get going? I just wonder if someone is more precise with their language does that affect the experience or is it kind of open to anyone?

Dr. Rosalind Watts [15:14] – Interesting, well often the experiences have this noetic quality which means that they’re beyond words, you can’t put them into words. So I think, really peoples’ … It doesn’t really matter. If you go beyond that, you go to a different level beyond that often. But, we do talk to them a little bit. We don’t prepare them for any kind of experience because we don’t want to prime them in any way. We just say, “If you feel that you’re dying, that’s okay. You’re not actually physically dying. We’ll look after you. It’s all fine.” But we don’t really prepare them because we just don’t know where they’re going to go so we just, the main preparation is just surrender. That’s the one word, surrender.

Craig Cannon [15:56] – Are both the other people in the room psychologists? Or they serve different roles?

Dr. Rosalind Watts [15:59] – In our next study, that’s just about to start, we’re going to have one lead guide and then one assistant guide. It’s a kind of training program where people then can get experience. There’ll also be the psychiatrist that’s not in the room most of the time but is on site if we need him.

Craig Cannon [16:15] – Are you taking notes or are you just hanging out? What do you do?

Dr. Rosalind Watts [16:21] – Last time we would take a book in with us sometimes because there’s a lot of time when they’ve just got the earphones in, the eyeshades on and they’re just lying back on the bed. There’s just silence for a long time. But this time we’re going to try not to do that because, actually, it’s just good to be there fully with them even though it’s a long day. It’s like six hours that they might be on this–

Craig Cannon [16:40] – Yeah, absolutely.

Dr. Rosalind Watts [16:40] – experience. But just really just being with them and seeing the subtle changes and listening to the music and being in the moment.

Craig Cannon [16:49] – That’s so great. The people that have participated in the study so far, do they have any shared qualities or traits? How does someone end up in this study?

Dr. Rosalind Watts [16:59] – In the last study people had treatment-resistant depression so it meant that they tried at least two different types of treatments that hadn’t worked. I would say, when I think back on those 20 people, they weren’t all psychedelic-enthusiastic. A couple of them had tried it before, but like 20 years ago. And actually, the one that had tried it before, had had a terrible LSD experience. He was really put off by it. The expectations about psychedelics were quite negative in many ways. And there was a lot of anxiety around them. But I guess also that maybe people had access to some media coverage of the positive possibilities of psilocybin so it was a bit mixed. There was some expectation that it might help them but they were scared about how they were going to get to that good outcome.

Craig Cannon [17:40] – Right, well it’s because they’ve all opted in to the session.

Dr. Rosalind Watts [17:42] – Yeah, they all opted in.

Craig Cannon [17:43] – They didn’t just end up in the–

Dr. Rosalind Watts [17:44] – But the reason they opted in, and I think this is all of them, is because they were absolutely desperate for something that was going to help them. They had tried everything. They’d had depression for an average of 18 years. And they’d tried between, I think, three and 11 types of antidepressants. Imagine trying 11 types of antidepressants and every time you go and your doctor gives you a different packet and they have side effects, and they take weeks to work and then they don’t help you. 11 types. They’d also had lots and lots of talking therapy. Up to six different courses of talking therapy. These are people that they would try anything. For some of them it was like ECT was the next option which is the electric shock therapy of the brain. People were like, “Well, I’ll try this and then if this doesn’t work, I’ll try ECT because it’s either this or I can’t carry on living like this. It’s either this or I’m out.”

Craig Cannon [18:36] – And is ECT proven to be effective?

Dr. Rosalind Watts [18:39] – Well, in some very severe cases, it might help some people but there’s also cognitive problems as a result of it. It can lead to severe cognitive difficulties and memory loss… Sometimes it works for people, but it’s really the last resort.

Craig Cannon [18:54] – Before you start taking psilocybin, so you’re taking these antidepressants. They’re super common, way too common in the U.S. Are there long-term effects of taking these medications? Because I know so many people are also manipulating their brain, who don’t necessarily have depression. They’re taking nootropics. They’re taking these focus drugs or whatever it might be. Have you found there to be any long-term effects?

Dr. Rosalind Watts [19:18] – With psilocybin?

Craig Cannon [19:19] – Not psilocybin. With these other…

Dr. Rosalind Watts [19:21] – Yeah. The research into the effect of antidepressant drugs often is very short-term. It looks at them for a very short period of time without much followup. Because that serves the purposes of the people making these drugs. I don’t know if long-term followup research, all I know about is the experiences of people that I’ve spoken to. In my clinical work, as a clinical psychologist, seeing people saying, “They make me feel worse.” Often people would say they made them feel worse. In terms of the long-term, With antidepressants, if they work well for people, then they keep taking them. If they don’t work then they stop taking them. We would be interested in the long-term effects of antidepressants for people for whom they are effective. But I suppose for those people for whom they are effective, they’re a complete lifeline. I don’t know about the research on that.

Craig Cannon [20:20] – I don’t understand it to the same degree as you do, but is it common for someone, if they do find an antidepressant to be effective to maintain use forever?

Dr. Rosalind Watts [20:31] – It is quite common for people to use it for a long time. For example, one of our participants had been antidepressants even though they hadn’t really helped him. They helped him a little bit. The way he described it was, “Life was really unbearable and the antidepressants took off the peaks and the troughs.” So the highs off the highs, the lows off the lows. It just made the range a bit more bearable. Even though he still felt very, very depressed, they kind of kept him going. He wouldn’t say they worked, but he took them anyway because when he, And the real reason, and this is the real thing that I don’t think gets talked about enough, the real reason I think that so often people stay on the antidepressants is because when they try and go off them, it’s awful. There was this one participant who’d been on antidepressants even though they hadn’t worked for 20 years. In our study, people have to come off their antidepressants in order to participate. Because it really, psilocybin is not nearly as effective if you’re on antidepressants. It really takes the–

Craig Cannon [21:26] – It takes the highs and the lows off–

Dr. Rosalind Watts [21:28] – Yeah, exactly. It stops that work from working, essentially. Coming off his antidepressants before the study, he was tearful the whole time. People described electric shocks going off in their brain. Bedwetting sometimes. That was somebody else.

Craig Cannon [21:45] – And how long are they off of these before they take psilocybin?

Dr. Rosalind Watts [21:49] – Well, for some people you have to withdraw them for quite a while because you can’t go into a psilocybin session with someone so turbulent. That was a shock for us. One of the big shock findings was, oh my goodness, me, withdrawing from antidepressants for these people was absolute hell often. That’s why some people stay on them because coming off is too difficult. But then a lot of people … We can talk about obviously the effects of the psylocybin, but it seemed to, for most people, last for about two or three months and then the depression starts to come back. And I think that’s because, for lots of reasons, but partly because this isn’t psychedelic therapy so we’re not giving people integration really. We’re not giving people the full package.

Craig Cannon [22:26] – What is integration?

Dr. Rosalind Watts [22:27] – A psychedelic intervention has to have three sections. Preparation, the session itself and integration. Preparation is, as we’ve talked about, getting used to how it’s going to be, getting to know each other, the trust. Building the trust. The session itself is about surrender. Being there together. And then the integration is about the participant themselves, weaving a narrative about what on earth they have just seen and gone through. They may have had mystical, spiritual experiences. They may have had experiences of dying. Amazing insights into their life. It’s a weird and wonderful world. And they need to piece it together in a way that makes sense to them. So that when they, in the months and years that follow, they know what that experience means, and it helps them live their life because there’s no use in having this incredible opening if you then go back to your same old life. What psychedelics do is they give you this window of opportunity. If you imagine.. So this is one of my colleague’s analogy I’m stealing from him. If you imagine like a snowy mountain and you go sledging and you go sledging down the same track and you always go, so there’s a track in the snow. It gets deeper and deeper and deeper. Well anytime you get on that mountain you’re going to the same track because it’s just the groove is getting deeper and deeper. If you imagine that as your mind in depression, you go through the same thoughts. Ruminating about the same things. Worthlessness, whatever it is, whatever your ruminations are, just thinking in that rigid pattern.

Dr. Rosalind Watts [24:01] – People describe it as like a mental prison. They’re stuck in the same old patterns. And then, with psylocybin or psychedelics it’s like you’ve got this mountain with these deep, deep ridges that you always go down and then with psylocybin it’s like a snowplow that just comes across and wipes everything through. In this state of brain connectedness or the entropic brain or the integrated brain, however you want to talk about it, it kind of wipes it clean. It doesn’t wipe your brain clean in the sense that it takes everything out of it, but it just provides this opportunity of flexibility. And then you can kind of sledge anywhere you want to go. So, after a psychedelic experience, people have this window of feeling really, often really fantastic for a number of weeks or even months. And this flexibility, “I can try this. I can try new things.” If in that window of opportunity, they start new habits, they change their relationships, they make those life changes, then we think that it can really last long, the effect can last longer. But, if you just give someone a psychedelic and you don’t encourage them to make the most of the window of opportunity, then what we found with our participants is that the depression came back after three months or so.

Craig Cannon [25:08] – It makes sense. Your life is already structured in such a way. It’s not like your memory is wiped clean, so you kind of fall into your habits as you would.

Dr. Rosalind Watts [25:27] – What’s happened? Of our 20, well, the first thing to say is that they all said that they would prefer it to any other treatment they’d tried. Three of them didn’t have a real effect from it. But they still, even though it hadn’t really worked for them, they still felt that the whole, something about the process, was very different to normal, it’s different from getting a pack of pills. It’s you’re sitting there. You’re talking to people. You’re getting to know them. They’re listening to your life story. It’s very human.

Craig Cannon [25:58] – And all of these people had had therapy before.

Dr. Rosalind Watts [26:00] – Yeah.

Craig Cannon [26:01] – Okay. It was even different from that.

Dr. Rosalind Watts [26:03] – It’s different to talking therapy, yeah. This difference in the relationship. It’s not the therapist sitting there and kind of trying to help, but not really having time to help. It’s like there’s something different about the way you go into it together. There’s a bond. You develop a bond. Even if it wasn’t effective, then there’s something powerful about that therapeutic bond because it’s quite different to how we do things in our culture. It’s a different philosophy.

Craig Cannon [26:31] – I’ve heard it frequently mentioned in the context of couples. Like having these experiences where they take mushrooms or whatever it might be. For whatever reason, they can work through something. Or people who work together take it together or all these things and it’s not the same thing as like, “Let’s have a coffee and talk.”

Dr. Rosalind Watts [26:50] – Yes, exactly. There’s something about the bravery of your going through this unknown thing together There’s something inherently bonding about that. So for three people it didn’t work. They didn’t have a psychedelic experience in that they didn’t really see anything even though they were on the same dose as everyone else. And we’ve got some ideas about why that might be, but we need more research to really work it out. So three of them it didn’t work. Then for six of them, at the six-month followup, they were still depression-free. The six of them, it really, it was life-changing, incredible–

Craig Cannon [27:25] – Yeah, yeah that’s wild.

Dr. Rosalind Watts [27:25] – amazing thing. And we’ve stayed in touch with people now, so that we know that actually, of those six people, for most of them, the depression did start to come back at some point around the year point. But some of them have had their own followup treatments. They have managed to keep themselves well through finding, because if you’ve tried something that works, and you want to try and find a way back to that thing again, so they’ve found places in the world where you can legally have it again.

Craig Cannon [27:49] – Ah, okay. So, but they need someone with them for the second, third–

Dr. Rosalind Watts [27:54] – Well, so let me tell you about the other 11.

Craig Cannon [27:56] – Yeah, sure.

Dr. Rosalind Watts [27:56] – And when we’re all done there, I’ll go to those. So for six of them, they were still well after six months. Three of them it didn’t work. And then for 11 of them, and this is, yes, so the majority of them, they were really well for three months, depression-free or very mild symptoms of depression. But then, after three months the depression starts to come back again. And, didn’t go quite back to how they had been before for most of them, but the depression came back. What’s been really hard for us is to have these people, so 17 out of 20, and these are people that nothing has worked for for years and years and years. 17 out of 20 people come and they have these experiences and it’s just a day. It’s not even that complicated. They take some capsules and they sit there for a day with you. And they feel better for months and months and months. Their partners say they have a sparkle in their eye that they haven’t had for decades. They’re starting new hobbies. They’re playing with their children more. It’s so beautiful to see. And then the depression starts to come back and then you have to say to them, “I’m really sorry, but we can’t give you another session because we’re a research study with no funding.” We all work for free all the time. We all cut corners in every way we can because we don’t, there’s no money here. Our team is based on the funding of one incredibly generous donor. And apart from that, we don’t have funding really. We’re so financially constrained that the budget that we do have we need to use on bringing this research forward.

Dr. Rosalind Watts [29:22] – We have an obligation to people with depression everywhere to get this treatment available to them. Our next study, we’re going to be looking at psylocybin versus antidepressants. We’re going to be comparing them.

Craig Cannon [29:34] – Oh, wow, okay.

Dr. Rosalind Watts [29:35] – And that’s an important thing to do. But, we’re spending all of our budget that we have on that study, which means that we just cannot give sessions to the previous people because if we did, we wouldn’t be able to do the next study. So we have to say to them, well we’ve said to them from the beginning, “We can’t give you followup days here. We have to keep forward in our research. We can’t….” It’s incredibly difficult and ethically hard to open peoples’ eyes to something that works. One person said it was like turning on the lights in a dark house. And then, it’s like the lights fade again. But they still say that now they’ve tried something that works, they have the hope that they can access it again. And some of them having been able to access it again.

Craig Cannon [30:12] – It totally makes sense. It’s like anything. It’s like exercise, right? If I were to go on a run every three months and that would be all I needed to stay in shape, that would be amazing. It’s incredibly effective. But it also makes sense that you have to keep at it. And so are they swapping it out for, people talk about going on these like ayahuasca retreats and you list the other comparables.

Dr. Rosalind Watts [30:36] – The only legal way of having this experience is there’s a couple of places where mushrooms are legal and there are retreats. But they’re very far away on the other side of the world. And, there are places in Europe where you can have ayahuasca ceremonies. And then there’s South America. It’s very difficult and you require, it’s the people with money very simply.

Craig Cannon [30:57] – You need cash.

Dr. Rosalind Watts [30:59] – A couple of our participants were able to access those. But the rest of them have not been able to.

Craig Cannon [31:05] – Okay, and is it common for them to get back onto the antidepressants or what are they trying to do?

Dr. Rosalind Watts [31:11] – A lot of them have stayed off the antidepressants.

Craig Cannon [31:13] – Really?

Dr. Rosalind Watts [31:14] – Yeah. But, some of them have gone back on just because they say, “Ugh, I need something to help me get through. It’s just life is just really tough.” ’cause things happen and someone’s farm got flooded and there’s kind of life happens and people, when they’re suffering from depression, they just need something and that’s the only thing that’s available at the moment.

Craig Cannon [31:34] – Could you walk me through? Because I haven’t been to therapy of any kind formally. I probably should, but, look–

Dr. Rosalind Watts [31:40] – I think we all should.

Craig Cannon [31:42] – walk me through how the conversation might flow? Because I just would like some context.

Dr. Rosalind Watts [31:50] – Yeah, so, the conversation in the actual sessions that I have?

Craig Cannon [31:54] – Yeah.

Dr. Rosalind Watts [31:55] – Okay, so, on a high-dose session, it would be quite, you would expect, it’s different every time so you just really don’t know, but it would be quite common, I guess, to have, the participant is lying there and I’m sitting there and sometimes holding their hand if they’re going through something painful. Sometimes not, just sometimes just sitting there. For a lot of the time it’s silence. And in their world, they’re battling things, crying and what you see is very little. They’re just lying there. It’s very internalized often. But then sometimes they might say, “I don’t want to go there. I’m not. I can’t.” They’re kind of struggling with something and so you’re just helping them to kind of face whatever is there. And then sometimes people are having a kind of rebirth experience. You’re a bit more like a midwife than a therapist. There’s kind of noises and sounds, and you’re reassuring, but you’re not really in an intellectual conversation because getting into the mind is, We want to get out of the mind and into the heart and into the body.

Craig Cannon [32:59] – Right.

Dr. Rosalind Watts [33:00] – As soon as you start, “What is that? What does it look like?” Then you’re back in the mind and–

Craig Cannon [33:05] – Yeah!

Dr. Rosalind Watts [33:05] – The brilliant thing about psychedelics is that they turn off that kind of ego frontal parts and that you can go into the body and into the heart and–

Craig Cannon [33:14] – You’ve had to totally retrain yourself?

Dr. Rosalind Watts [33:16] – Yes.

Craig Cannon [33:17] – Like that’s completely against everything you studied, I imagine.

Dr. Rosalind Watts [33:18] – Completely.

Craig Cannon [33:19] – And so, are you asking different kinds of questions or is it just encouragement?

Dr. Rosalind Watts [33:28] – That sounds really ridiculous. But when you boil it down, that’s what it is. It’s presence. It’s presence and it’s love. And to me they’re kind of the same thing in that when you’re there, in the same way as when you’re … Well, I think, actually, my own experience of having a baby and looking after a small child, which happened alongside it, so I was doing guiding in my maternity leave. So I had a three-month-old baby at home when I was going, you know–

Craig Cannon [33:55] – Whoa! Okay.

Dr. Rosalind Watts [33:56] – for the first time, when I first started doing this work. Now she’s nearly three and so, I think my parenting work or my mothering is actually probably something that helps me the most in understanding what the presence that is needed. Doesn’t mean that it can’t be men as well. Men and women both can bring that kind of, I guess it’s a kind of like unconditional… The humanistic psychologist used to talk about unconditional positive regard, which is a kind of, a broad approach of just, whatever you do, I accept you. And, but it’s kind of one step further, because when you’re seeing people going through this kind of pain, you do feel a sense of love in a different way. Just human, it’s not like falling in love with patients. It’s like a human compassion and feeling of shared humanity together. And a feeling of you’re just so with them. And they’re vulnerable. They’re vulnerable. There’s just something special about that kind of therapeutic relationship. It’s very different.

Craig Cannon [35:01] – Yeah, and so someone who’s been on the other side of therapy, like traditional. What is your experience? How does it contrast?

Dr. Rosalind Watts [35:09] – I did some research into this. I interviewed people from the study and I asked them to compare it to the previous therapy they’d had. In a way, it did really surprise me because I’d been doing CBT, this cognitive behavioral therapy, for years and, that was my practice and I thought it had been kind of helpful-ish. I always knew that it wasn’t really that helpful and people weren’t always getting better but it was kind of helpful. But what people in our study said was that once they’d had the psylocybin and that experience what it was like to have something that was kind of a different kind of relationship, they looked back on the talking therapy they’d had and just felt that it was quite, And I think they’d had bad experiences. It’s not always like this. I have colleagues that are brilliant therapists and I know that they’re clients wouldn’t feel this way. But, sometimes, it can be really directive. It’s like, I’ve studied all this. I know what the theory is. I know what the model is. This links to this links to this. And we have all these diagrams that we learn when you’re training to be a clinical psychologist of like eating disorder, OCD, depression and you have all these arrows. And it’s like this happens here, here, here, so you’ve got the system in your head.

Craig Cannon [36:25] – Yeah, it’s like, “You are INFJ. This is what you do.”

Dr. Rosalind Watts [36:28] – Yeah, exactly. And I’ve got to get you to here. And there’s quite a lot of pressure on you to get them there. You do this thing called Socratic questioning which is this technique where you kind of know what the answer is but you need to make the person feel that they’re getting to the answer so it’s, “Ah but I wonder what would happen if …” It’s directive because you’re trying to get them somewhere. You think you know the answer. And you’re the therapist. And you’re the one that trained. And you’re the expert. And they’re coming to see you. And with psylocybin it’s completely different because the expert is themselves. They are the expert because what’s happening, the healing power of this, is something in the unconscious mind. Their own unconscious mind is righting itself. There’s a homeostatic principle at play here. I’m sure of it. If you think of your body as a system, your body and mind as a system, whatever things need dealing with, whatever problems there are in the system, forget our manual of A, B, C, D, whatever is actually going on in this holistic system, the psylocybin helps, just kind of goes there somehow. The unconscious mind is incredibly intelligent and knows which parts of the system are a bit weak or a bit faulty and which need changing so it can fix the glitches in the system somehow. And this is this kind of brain connective. All the parts are talking to each other so it’s like almost this kind of scanning process of like, “Okay, we’ve got all the information. Where do we need to go to?”

Dr. Rosalind Watts [37:51] – What that means in terms of the relationship is that there’s complete respect for them because they are the ones that are going on their own journey. You can’t go on it for them. It’s not directive in any way. We have no idea where they’re going to go. Say you were coming for a session, I would have no idea, really, about what would be the right thing. Whenever I tried to have ideas, when I first started, they were always wrong because the person’s own mind is infinitely more intelligent than I am.

Craig Cannon [38:18] – Right, well, they just know themselves.

Dr. Rosalind Watts [38:19] – They know themselves! Exactly!

Craig Cannon [38:22] – You’re in a constant conversation with yourself. One thing I always wondered about therapy, having known a bunch of people that have gone through it. Is it that matchmaking process?

Dr. Rosalind Watts [38:32] – Yeah.

Craig Cannon [38:32] – Because I’ve often met someone who’s a therapist and I’m like, “I don’t know if you’re the right fit for me.” Do you find that to be a real thing or is that just my own resistance to not wanting to do it?

Dr. Rosalind Watts [38:45] – It’s a very important point. Absolutely for talking therapy especially if it’s longer-term talking therapy when you’re going weekly for someone for maybe a year or something or a couple of years. So key that relationship. All the work is done within that relationship. But with psychedelics, the work is really, really done on the inside. The match is important in the sense that, if there was a dislike there … You know, we all meet people that sometimes, for whatever reason, they activate something in us that makes us think about someone we don’t like, or if there was a dislike and there wasn’t trust, that would be a problem. The participant and the guide have to trust each other. Really, really trust each other. But that’s usually okay as long as you kind of, obviously not all therapists would be guides. It takes a particular kind of approach. Not needing to be the expert. Not needing to talk about stuff in an intellectual way. Being comfortable with emotions. Being comfortable with not knowing. Being comfortable with being a loving presence and patient. It’s not something that is going to suit–

Craig Cannon [39:46] – It’s not everyone.

Dr. Rosalind Watts [39:46] – all therapists. Not everyone. And not all people would be kind of, would really trust the process enough to be able to go through it. Some people might be quite suspicious of it or just not really feel it was right for them. It’s not right for everybody. But for the people through our screening process, the people that we had come through, and the therapists that we had, it tended to be fine. We have one person, he wasn’t fully trusting of his guides before it went through and actually he had a good outcome, but I think he could have done with a few more sessions beforehand. Usually the trust is there, but beyond that trust, I don’t think the matching matters because … Okay, say I’ve got issues with my mother. It might be that when I go and have talking therapy I might want to go and see a woman, maybe, to work through that relationship. And I might want someone kind of my mom’s age. And it might, maybe, maybe not. Those kind of factors don’t really matter in psychedelics because you’re going to be going through you’re.. If you’ve got an issue with your mother, you’re going to maybe going through that in your session, perhaps, if that’s the area that the scanning process decides is the most relevant. But you’re going to be doing it yourself. You might be face to face with your mother in the session, but the guides aren’t there to take part in the psychodrama. The work isn’t done with them. They’re just kind of nice people helping you be there. They’re not so much part of the healing.

Craig Cannon [41:13] – Okay, it’s that’s a very different process. With talking therapy, I always, my concern was that I was just going to look for confirmation.

Dr. Rosalind Watts [41:20] – Yes.

Craig Cannon [41:20] – And so I would look for someone that’s so close that it just wouldn’t necessarily break through.

Dr. Rosalind Watts [41:26] – And that’s the other thing, great thing, about psychedelics as well, actually, is that actually I can own this from being a exhausted psychotherapist in the NHS seeing lots of people. By the time the 8th person came through the door on a Friday, I was so exhausted I might not remember their notes. And I might sit there, and what I would fall back on is just being nice. Being a nice, kind person. I hear you and I’m there for you. But when I talk about the love of a psychedelic session it’s like a tough love. There’s no nice about it. As a guide you’re sometimes pushing them to face really difficult things. And the psylocybin experience itself is often extremely confronting. There’s no like platitudes or confirmation of like, “Yeah, you’re doing great. You keep going.” No.

Craig Cannon [42:15] – But then you’ve seen it, right? There’s kind of this period where it works and then it stops working. Well, the long-term effects aren’t necessarily there. How are you thinking about setting up someone for success? You have another study coming out. What are you going to do to get someone on the right track?

Dr. Rosalind Watts [42:33] – If someone gave me a license to use psylocybin legally in lieu of the money, then I guarantee you I could set up something that would, well we all, loads of people who work in this field, we all have ideas. We’ve working on the work of the people that were doing this decades and decades ago. There are loads of different models that we think would be really useful to mix together. Like various psychological models that actually lend themselves really well to this. And meditation is the key thing. Mixing meditation in this. In a perfect world, it would be seen as something that, it’s a journey. It’s a long journey into the deepest, deepest parts of yourself. And from that place you’re hoping to find the self-acceptance, the self-knowing, the self-love that enable you to radically transform your relationships with yourself, with other people and the world around you. That was the theme that came out of my research looking at the outcomes was that people felt more connected to themselves, to other people in the world around them. I would look at things that help people continue that process. It would start off with the prep phase. It would go into the sessions. And then the integration would be something that help people maintain their learning and maintain a sense of community, stay connected to other people. And a sense of meaning in the world. Like we’re not just doing it in a vacuum. There’s people have real insights about their values and about the way the world should be and the way the world is and they change their behavior in line with it.

Dr. Rosalind Watts [44:09] – Things to help people continue with that. And it’s not the therapist saying, because that’s the other thing I would do in talking therapy before I would say, “We need to set some goals. What things are important to you? Let’s set these goals.” And the feedback I got from the participants in our study was that they didn’t like when they had that kind of thing before. They didn’t like it because it was someone just kind of telling them what kind of goal to have and they would feel that they would fail at them and it would just make them feel worse. Who knows what the right goals is? But with this psychedelic experience people can, they come out with the strangest most unpredictable goals. Beause actually what you thought was right for someone wasn’t going to be right. They get this idea that, what I really need to do is A, B and C. It would be supporting people to maintain those insights and new goals. But the key thing as well, it wouldn’t be like a kind of one session, then you’re okay forever. It would be, the long journey would be one where people might have a psylocybin experience every six months. They might have a period where they had like four six months apart and then they’re okay for like 10 years. And then they might come for a top-up. But it would very individually decided upon. You’d work out with someone if they needed another session or not. But it’s a life journey you know. It would be something that they would then, for deep self-reflection through different life stages.

Dr. Rosalind Watts [45:23] – Maybe someone in their 30s, they would have three sessions and then feel pretty well in their 30s and 40s. And then at 60 they retire and things get really difficult and they’re having to recalibrate things, and they come back for another psychedelic session and they go back inside and they …

Craig Cannon [45:39] – Interesting.

Dr. Rosalind Watts [45:39] – I’d see it as an ongoing thing.

Craig Cannon [45:41] – That confidence to make a change, is change a more common thing versus talking therapy, rather than is talking therapy more conducive to…this is not the exact word, but coping? You have this certain situation. You’re going to be able to deal with it in such a way versus psylocybin therapy where someone might be like, “I can’t do this anymore. I’m going to become a painter.” Or something like that. Is that a difference?

Dr. Rosalind Watts [46:10] – That’s an interesting one. I don’t think it’s quite… Certain types of talking therapy are more like… CBT and things like that, short-term therapies, are more about coping, coping strategies, helping people kind of keep going with the situation they’re in. Whereas things like psychoanalysis are more about deep, internal change. Understanding their unconscious mind and how it’s infecting your behavior and making deep changes. But it takes many, many years to get to that. I’d say psychedelics are a bit more like psychoanalysis in that it’s learning to, understanding yourself much, much better in a very deep way and making changes. Where for psychoanalysis it might be a bit more gradual, that people might get to know each other much better over say, 10 years of analysis and many, many thousands and thousands of pounds spent on it, they might start to understand themselves better and make those changes. With psychedelics it can suddenly seem a bit more revolutionary. But we do encourage people, after a session, not to make any big changes for a coupla weeks.

Craig Cannon [47:10] – Oh, okay.

Dr. Rosalind Watts [47:11] – Just to let it sit and percolate. Because people often say I want to change my job or I want to do this. And in our ensemble of 20 people, people did make changes. New jobs, did things they’d been frightened of for a long time, changed relationships. People did make big life changes, but we do encourage caution.

Craig Cannon [47:34] – For the people who don’t necessarily have access to traveling to South America or participating in your session, what do you advise them to do? You’ve mentioned meditation before. We talked it about it before we even started recording. That seems pretty important.

Dr. Rosalind Watts [47:51] – Yeah.

Craig Cannon [47:52] – What do you tell them?

Dr. Rosalind Watts [47:53] – You can access these states without psychedelic drugs. Psychedelic drugs are just one way of accessing these states. Breathwork, holotropic breathwork was developed by Stan Grof. After psychedelics were made illegal, Stan Grof had been working in psylocybin and LSD research in the states in the same place as Bill Richards who I mentioned before, for decades. And then when they became illegal, he developed, with his wife, this other technique to enable people to get to the same states. You could do holotropic breathwork workshops. We’re doing training for our new therapists this week and on Saturday we’re all going to be doing a holotropic breathwork workshop together because it’s a legal way of inducing these experiences. Meditation, like deep, deep meditation practice. It might take a long time to get there, but you can access very, very similar states as well. Also, in a way, it’s easier. Psychedelic experience can be really, well, it’s hard to find and then even if you do find it, you access it. It’s, even for the people in our study, or at a ceremony, it’s intense and hard and draining. Whereas meditation you can start small and build up and you can fit it in your day. I’ve had a meditation experience that was fully expansive. I’ve only had one ever. May never have another one. But it was enough to make me know that it’s serious. In the same way that psychedelics, if they deactivate the default-mode network, which is your kind of ego, the brain base of the ego, meditation does that too.

Craig Cannon [49:26] – It quietens down that mental control, the monkey mind. It’s quieting the monkey mind. That’s all, I would say, really you’re doing with psychedelics and with meditation. And then what about maintaining the change? Maintaining the desire to change?

Dr. Rosalind Watts [49:42] – You mean with meditation or just generally.

Craig Cannon [49:44] – Any and all of the above. The reality is that most people listening or watching or whatever probably won’t go through this process, but they, almost everyone knows that feeling of… There’s this book, The War of Art. Have you ever read it before?

Dr. Rosalind Watts [50:00] – No.

Craig Cannon [50:01] – It’s by an author Steven Pressfield and he talks about resistance and often times the resistance to push through, to really go for your creative project or whatever it might be. Because so often people from deep down kind of know the thing that they want to be working on, but there’s a fear or there’s pressure. There are a million reasons to not do that thing.

Dr. Rosalind Watts [50:23] – Yeah.

Craig Cannon [50:24] – I’m just curious if you often recommend a book or a certain thing to someone.

Dr. Rosalind Watts [50:32] – Hetting connected is the thing. When you deactivate the thing that keeps you trapped and you can get down to your real… When you turn off the mind or the ego, however you do that, whether it’s meditation or walking in nature, whatever you do, you turn that off and you get down to your, I would call it your soul, but your space of who I really am. That little voice inside you that knows what it really wants to do. When you know what it is that your life is about or the thing that’s going to make you feel meaning and feel happy and feel that you have a purpose, then don’t let go of that for anything. But the way to make that happen is to get connected. Because it’s very easy to… We’re trapped in our head and in our culture in the West we’re very, very disconnected from each other and from ourselves most of the time. Kind of whatever addictions we’ve got, whether it’s Netflix, or beer or whatever, we’re just kind of like operate in this frenzied kind of hamster-wheel existence. When you turn that all off and you get down into who you really are, you need to honor that. The theme, as I said before, about what psychedelics do is make you more connected to yourself, others and the world around you. That is the thing. That’s kind of my motto anyway of like, connection to myself. What’s my connection to myself? How am I nourishing myself? How am I listening to that voice? How am I prioritizing that voice above the other chatter of the world? Connection to others. It’s difficult to achieve anything on your own.

Dr. Rosalind Watts [52:03] – But, finding your tribe, finding the other people that you are going to do this with. Whatever your dream is, find other people that you’re going to do it together. And then connection to the world is really just, kind of thinking about what it means and the ethical roots of what you’re doing, and the value systems and and helping it spread wider and wider. So, onnect. The interesting thing about mushrooms, in a forest, you’ve got all the different trees, and I think 2/3 of the forest is underground. You can see 1/3 of it which is the trees. But 2/3 of it is underground. It’s like the roots that go down. And the way trees communicate with each other is through mycelium. And mycelium is mushroom. It’s fungus. The whole of the forest communicates through this layer of mushroom. Mushroom is a great connector and you can think about that analogy really, if you imagine yourself as a tree. And you’ve got your trunk, which is your connection to yourself. And you’ve got your branches which is your ideas going out. And then you’ve got your roots and you’ve got this layer of mycelium and your connected to all these other people. And so to make your tree grow really strong, it’s about your place in the forest. You’re not standing alone.

Craig Cannon [53:24] – That’s great. I think that’s a great place to stop. Thank you so much for your time

Dr. Rosalind Watts [53:29] – Thank you.

Craig Cannon [53:32] – Alright. Thanks for listening. As always, you can find the transcript and video at blog.ycombinator.com. If you have a second, it would be awesome to give us a rating and review wherever you find your podcasts. See you next time.